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BUTTONHOLE CANNULATION RESULTS: NETWORK 11 February 2008

BUTTONHOLE CANNULATION

RESULTS: NETWORK 11

February 2008

BUTTONHOLE CANNULATION RESULTS: NETWORK 11 February 2008

Background In summer of 2007, Network 11 participated in a national project to discover current practices with buttonhole cannulation. Of the 18 ESRD Networks, 14 took part in the project, with about 5,100 fa- cilities participating. For more information on the national proect, please visit www.fistulafirst.org.

Method All facilities in Network 11 were asked to participate in the Buttonhole Technique Scan. Question-

naires were sent to the nurse manager of each facility by email. Participants were asked to complete

the questionnaire and return to Network 11’s office by email or facsimile. ties returned a completed Buttonhole Technique Questionnaire.

A total of 146 (45%) facili-

Results Use of Buttonhole Cannulation. In Network 11, about one-third (33%) of facilities who responded reported having at least one patient using the buttonhole technique for cannulation. Facilities had a varied use of the technique, ranged from 1 to 40 patients using the technique. In addition, 8 facili- ties cited using the buttonhole technique for arteriovenous grafts (AVG), in addition to arteriovenous fistulas (AVF). Figure 1 shows the breakdown of the percentage of patients that use the buttonhole method of cannulation in Network 11 facilities. The majority of facilities use buttonhole for 10% or less of their patient population, but a small number of facilities have placed buttonhole as their pri- mary cannulation method, using the method for as many as 88% of their patient population.

Figure 1. Percentage of Patients Using Buttonhole Cannulation in Network 11 Facilities

60% 53.3% 50% 40% 30% 20% 22.2% 17.8% 10% 6.7% 0% 0 to 10% 11
60%
53.3%
50%
40%
30%
20%
22.2%
17.8%
10%
6.7%
0%
0 to 10%
11 to 25%
26 to 50%
Over 50%
Percent of Facilities

Percent of Patients Using Buttonhole

Of those facilities that reported using buttonhole cannulation, the amount of time each facility used the method varied, ranging from 2 weeks to 8 years. The average length of time for all Network 11 facilities was 4.3 years. Figure 2 shows the breakdown of buttonhole experience, with the majority of facilities (78%) performing the buttonhole method less than 1 year.

Figure . Length of Time Using Buttonhole Cannulation in Network 11 Facilities

90% 80% 77.8% 70% 60% 50% 40% 30% 20% 10% 11.1% 6.7% 4.4% 0% One
90%
80%
77.8%
70%
60%
50%
40%
30%
20%
10%
11.1%
6.7%
4.4%
0%
One year or less
2 to 3 Years
4 to 5 Years
More than 5 Years
Percentage of Facilities

Length of Time Using Buttonhole Cannulation

Complications with Buttonhole Technique. The majority of facilities (61%) stated that they have had no complications using the buttonhole method of cannulation for their current patient population. Those facilities citing no complications (91%) have almost exclusively been practicing buttonhole can- nulation for under one year. Those facilities who reported complications cited a wide range of experi- ence with buttonhole cannulation, ranging the full spectrum of 2 weeks to 8 years, with an average of 2.5 years.

Facilities that reported complications gave a variety of reasons. A total of 27 complications were cited, with the majority (41%) being the inability to transition to blunt needles. Figure 3 gives the

Figure 3. Complications Using Buttonhole Cannulation in Network 11 Facilities

50% 40% 40.7% 30% 20% 18.5% 18.5% 10% 11.1% 11.1% 0% Inability to transition to
50%
40%
40.7%
30%
20%
18.5%
18.5%
10%
11.1%
11.1%
0%
Inability to transition to blunt
needles
Excessive bleeding
Other
Infiltration
Infection
Percentage of Total Complications

Complications with Buttonhole Cannulation

remaining breakdown of complications experienced. Other complications cited include the develop- ment of multiple tracts, development of blood clots, leaking around needle sites, vessel bloodflow problems, and the inavailability of staff to perform the cannulation.

Buttonhole Cannulators. The majority of facilities reported the use of multiple cannulators using the buttonhole method. Figure 4 shows the varying facility practices, but the majority of facilities use dialysis nurses and patient care technicians to cannulate buttonhole sites, with some facilities also us- ing patients and/or their family member to cannulate the buttonhole sites.

Figure 3. Types of Buttonhole Cannulators in Network 11 Facilities

100% 80% 81.6% 60% 63.3% 40% 38.8% 26.5% 20% 0% Dialysis Nurses Patient Care Technicians
100%
80%
81.6%
60%
63.3%
40%
38.8%
26.5%
20%
0%
Dialysis Nurses
Patient Care Technicians
Patients
Patients Family/Helper
Percent of Facilities

Type of People Performing Buttonhole Cannulation

Staff Training. Facilities reported using multiple methods to train staff to perform buttonhole can- nulation. The majority of facilities (53%) reported using inservices at the dialysis facility, with other training options included, such as vendor training, training offered within their dialysis corporation, and training offered by the Network. As facilities implemented the buttonhole method of cannulation, further educational offerings were used to augment the initial training, including training offered at national conferences, regional workshops offered through the Network, ANNA (American Nephrology Nurse Association), or vendors, scientific journal articles, and web sites. Of all of these options, facili- ties cited websites (43%) as the resource most used for staff education.

Conclusions Although a strong number of facilities in Network 11 have expressed interest in buttonhole cannula- tion, only a third of respondents reported actually using the method in their facility. Occurence of complications are few, but present in those facilities who have used the buttonhole method for a longer period of time. Both consumers and dialysis staff are participating in this method of cannula- tion, and many facilities have used the multiple educational resources available on the web and at national, regional, and local workshops. As the use of buttonhole cannulation technique gains further interest, this education and support will be called upon to make this Fistula First strategy a success for a greater number of facilities.